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CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) update 2022.

Authors:
Yukio Ozaki Hironori Hara Yoshinobu Onuma Yuki Katagiri Tetsuya Amano Yoshio Kobayashi Takashi Muramatsu Hideki Ishii Ken Kozuma Nobuhiro Tanaka Hitoshi Matsuo Shiro Uemura Kazushige Kadota Yutaka Hikichi Kenichi Tsujita Junya Ako Yoshihisa Nakagawa Yoshihiro Morino Ichiro Hamanaka Nobuo Shiode Junya Shite Junko Honye Tetsuo Matsubara Kazuya Kawai Yasumi Igarashi Atsunori Okamura Takayuki Ogawa Yoshisato Shibata Takafumi Tsuji Junji Yajima

Cardiovasc Interv Ther 2022 Jan 12;37(1):1-34. Epub 2022 Jan 12.

The Cardiovascular Institute, Tokyo, Japan.

Primary Percutaneous Coronary Intervention (PCI) has significantly contributed to reducing the mortality of patients with ST-segment elevation myocardial infarction (STEMI) even in cardiogenic shock and is now the standard of care in most of Japanese institutions. The Task Force on Primary PCI of the Japanese Association of Cardiovascular Interventional and Therapeutics (CVIT) society proposed an expert consensus document for the management of acute myocardial infarction (AMI) focusing on procedural aspects of primary PCI in 2018. Updated guidelines for the management of AMI were published by the European Society of Cardiology (ESC) in 2017 and 2020. Major changes in the guidelines for STEMI patients included: (1) radial access and drug-eluting stents (DES) over bare-metal stents (BMS) were recommended as a Class I indication, (2) complete revascularization before hospital discharge (either immediate or staged) is now considered as Class IIa recommendation. In 2020, updated guidelines for Non-ST-Elevation Myocardial Infarction (NSTEMI) patients, the followings were changed: (1) an early invasive strategy within 24 h is recommended in patients with NSTEMI as a Class I indication, (2) complete revascularization in NSTEMI patients without cardiogenic shock is considered as Class IIa recommendation, and (3) in patients with atrial fibrillation following a short period of triple antithrombotic therapy, dual antithrombotic therapy (e.g., DOAC and single oral antiplatelet agent preferably clopidogrel) is recommended, with discontinuation of the antiplatelet agent after 6 to 12 months. Furthermore, an aspirin-free strategy after PCI has been investigated in several trials those have started to show the safety and efficacy. The Task Force on Primary PCI of the CVIT group has now proposed the updated expert consensus document for the management of AMI focusing on procedural aspects of primary PCI in 2022 version.

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http://dx.doi.org/10.1007/s12928-021-00829-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8789715PMC
January 2022

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